February 4 marks the World Cancer Day, an international day meant to raise awareness of cancer and also to encourage its prevention, early detection, and appropriate treatment. Of all the diseases one hears and talks about, one disease outscores the rest in its ability to terrify and shock anyone and everyone. Cancer is various addressed by alternatives such as “killer disease” “disaster disease” etc. Kashmiris often address it as “nakaar dodh”. As per latest data, the cancer incidence (occurrence of new cases) in various states of India ranges from 58 to 133 per 100,000 population. In the state of Jammu and Kashmir, the cancer incidence is 79 per 100,000 population. But what exactly is cancer? How is it caused? What are its symptoms? Can we do something to prevent it? If it happens to anyone, is there hope for disease control or cure? What are the myths associated with this disease?I will take these questions one by one in this article.
What exactly is Cancer?
The most basic unit of the human body is a cell. A human body has about 35 trillion cells! In a normal individual, cell division and cell death is an amazing and a tightly controlled process. While we go about our daily tasks every day, these multitude of cells are meticulously working on their own. This amazing machinery of the cells in the human body goes about its job in a smooth manner, unknown to us externally. Occasionally, however this meticulously controlled process goes astray. In simple terms, cancer is an abnormal growth or a cell or a group of cells in a particular organ of the body. These cells start multiplying on their own and do not recognize that inhibitory signals that stop the normal cells from dividing.
How is it caused?
At the cell level the normal division process gets deviated from its tight control. This can happen for a number of reasons. This could be related to genetic factors, environmental factors, life style and other things. In many cases, however, it may not be possible to pin point the exact cause of cancer. One of the most well known risk factor is use of tobacco in any form, smoking, paan masala, gutka and other variants. Other risk factors include alcohol intake (especially heavy intake), gross obesity, strong family history and others.
What are the symptoms of cancer?
Symptoms of cancer can be varied. The symptoms for which one needs to be concerned, especially if they persist are
• Persistent cough or blood-tinged saliva
• A change in bowel habits
• Blood in the stool
• Unexplained anemia
• Breast lump or breast discharge
• Lumps in the testicles
• A change in urination pattern
But please remember that having above symptoms does not mean that one has cancer. In fact most often, these symptoms are due to some benign reasons. However, if your symptoms last for more than a couple of weeks, it is important to see a doctor so that problems can be diagnosed and treated as early as possible.
Can we do something to prevent Cancer?
Certainly! One of the important steps in this direction would be to give up tobacco in any form, if one has been using it. Tobacco is a known risk factor for several cancers such as those of the throat, lung, food pipe (esophagus), and urinary bladder to name a few. The good news is that even for people who have been smokers for long, the risk of developing cancer drops as soon as they stop smoking for good.
We should try to achieve and maintain a healthy weight throughout life. This means being as lean as possible but not going to the extreme and becoming underweight. Gaining weight needs to be avoided at all ages. Further, it is recommended that everyone adopts a physically active lifestyle. The present day international recommendation is to do at least a total of 150 minutes of moderate-intensity physical activity or a total of 75 minutes of vigorous intensity activity each week, preferably spread throughout the week. A disturbing trend in present day children has been that they are hooked to television or smartphones and compromise on their outdoor activity. It is strongly recommended that children and adolescents should engage in at least 1 hour of moderate or vigorous intensity activity each day.
Everyone needs to consume a healthy diet with emphasis on plant resources. Sugary drinks and energy dense foods need to avoided or drastically cut. It is recommended to eat at least 2-3 cups of fruits and vegetables every day, using a variety of of vegetables, fruits, whole grains, and legumes. Consumption of salty foods and foods processed with salt needs to be curtailed. What about alcohol intake? If you are already drinking alcoholic beverages, limit their consumption. If you are a teetotaler, then please enjoy, there is no health reason to begin alcohol intake. Please remember that there are no dietary supplements that are proven to protect against cancer, so kindly do not waste money with these (often exorbitantly priced) products. And finally, it is best for mothers to breast-feed exclusively for up to 6 months (and more), and this promotes healthy living and weight control both in mothers and infants. Optimum use of cancer screening test especially for breast, cervix, lung and colorectal(sucha as mammography, pap smear etc) are available but need to be used in consultation with qualified oncologist.
Can we cure cancer?
We are much more equipped to deal with cancer than ever before. Medical Science has progressed in leaps and bounds. The triad of management of cancer includes surgery, chemotherapy and radiation therapy. Some patients may require only one treatment modality, some two and some others may require all three modalities for cancer management. This would depend on the site of cancer, the general condition of the patient and the stage of the disease. All cancer treatment modalities have undergone big advancements and these have in turn improved the side effect profile of these modalities. Present day surgery includes the options of open surgery, laparoscopic surgery and robotic surgery. Systemic therapy includes option of chemotherapy, hormonal therapy and targeted therapy. These therapies are given either through the injectable route or the oral route. As evident these treatments exert their effect throughout the body.
Radiation therapy includes sophisticated treatments such as Image guided radiotherapy (IGR), intensity modulated radiotherapy (IMRT) and 4 D treatments (which account even for respiratory motion while the patient is being treated). Most modern oncology centers would have this equipment. What is to be noted however is that patients need to ensure two things before going to a cancer center: quality equipment and quality doctors. The qualified oncologist guides the patient regarding the treatment sequence. It is always preferable to have the entire cancer treatment after carefully selecting a center (instead of doing part of treatments at different centers). After treatment, the patient is supposed to come for follow up as per given advice.
What are the common myths regarding cancer?
Most cancers that occur are not related to genetic factors, as is widely believed. It is only a small minority of patients that can be related to bad genes. Many lay persons feel that cancer can be transmitted by close contact. The fact is that cancer is a non-communicable disease. There is no chance of person to person transfer of this disease by close contact. Some people feel surgery causes dissemination of cancer, which is another big myth. Another wrong perception in lay public is that radiation therapy caused burning of the body or makes the person radioactive. Radiation therapy typically involves treatment by high precision X rays and does not insert radioactivity in the patient. The primitive radiotherapy machines that used to leave ulcers on the treatment are a thing of the past.
Socio economic aspects
The word cancer has a stigma associated with it and this needs to be done away with. It is important for us as a society to respect the feelings of a patient, be it cancer or be it any other disease. Some patients are quite fine declaring their disease, some others want to keep things to themselves or their close family. In either case, our society needs to come out of the stigma associated with this diagnosis. Treatment of cancer can be a prolonged process, lasting a few months, if more than one treatment modality is needed. So the patient as well as the immediate caregivers need to be “patient”. Also, the treatment of this disease can be expensive, especially at private centers, and I would urge the community (both young and old) to take adequate health insurance while they are healthy. The premium for a health cover may seem an unnecessary expense while one is healthy, however this small expenditure can be a big financial help in cases of any medical illness..
Take home message
First take all the steps to promote a healthy lifestyle in you and your family. If you are a smoker (or use tobacco products in any form), stop its use. Today! Remember it is never too late to stop. Regular exercise and taking care of one’s diet are other essentials. If anyone does fall prey to this disease, do not panic. The diagnosis of cancer does not mean a death sentence. It should be considered as just another disease and managed with proper medical guidance, that is all.
Wishing our entire community a long healthy life!
Dr Anusheel Munshi